Coding Quality Reviewer and Educator-4
Core
Perform comprehensive audits of professional coding and clinical documentation to validate accurate ICD-10-CM, CPT, and HCPCS code assignment and ensure compliance with CMS regulations and payer policies.
Role type
Senior IC coding auditor and educator
Builds
Compliant, defensible documentation and optimal revenue integrity outcomes
Domain
Healthcare / Medical Coding and Compliance
Required skills
Expert knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines, E/M and surgical/procedural coding, medical terminology and anatomy, interpretation of complex medical documentation, analysis of audit data, research of regulatory guidance from CMS and payers
Preferred skills
Prior coding audit experience, experience performing provider and coder education, Epic EHR proficiency
Technologies
Epic, Microsoft Office Suite (Word, Excel, PowerPoint)
Responsibilities
Perform prospective and retrospective audits of professional coding and medical records to validate accuracy and completeness of code assignment, Evaluate clinical documentation to ensure services billed are supported and compliant, Document audit findings, variance details, and supporting rationale in an objective, audit-defensible format, Identify root causes of coding discrepancies and collaborate on corrective action plans, Develop and conduct targeted education to coders, providers, and clinical departments based on audit findings, Track and trend audit results to identify systemic risks and process improvement opportunities
Seniority
Senior, hands-on IC
